As practitioners working from a holistic approach, we can often get caught up in a way of thinking that is often considered holistic - The body vs the environment or, the body vs food. We may hear or give advice such as “gluten causes inflammation” or “chemical exposure is carcinogenic”. But, what if we were to shift our perspective, and instead, approach our work by considering how our bodies interact with our environment, and what is expressed as a result?
Introducing the exposome - The concept was coined back in 2005, and with 15+ years of research, has now become a truly holistic approach to working with clients. The exposome takes into consideration ecosystems, physical chemical exposures, social and lifestyle aspects when thinking about what external forces can alter our biology. What makes this concept different than what most of us have come to know as a holistic approach to health, is that the exposome defines exposure to toxins and toxic effects in a much more interactive way :
As Rappaport and Smith described in 2010, “toxic effects are mediated through chemicals that alter critical molecules, cells, and physiological processes inside the body…under this view, exposures are not restricted to chemicals (toxicants) entering the body from air, water, or food, for example, but also include chemicals produced by inflammation, oxidative stress, lipid peroxidation, infections, gut flora, and other natural processes” (1)
This is the future of functional medicine and a truly holistic approach to health. And as practitioners, we must begin to shift our perspective, and the language we use with clients, accordingly.
While the topic of the exposome is a big one, here are a few things to consider as you begin to navigate this approach :
#1 - The human body interacts with its environment, and expresses itself as a result of what it interacts with.
The exposome is an interconnected function of what we do, where we live, what we eat, what we experience and what our body does in return. The exposome is divided into the following categories :
Examples - Income, cultural norms, physical and psychological stress
Examples - Blue and green space, population density, walkability of living space
Examples - Smoking, alcohol use, daily diet
Physical - Chemical
Examples - Ambient light, noise and odors, molds, pesticides, plastics, electromagnetic fields
After considering someone’s exposome, we can then look into how the body is interacting with it via blood work, food and lifestyle logs, chemical exposure analysis or organic acids via urine, etc, and relate this back to their symptoms and goals for seeing you in the first place.
#2 - Not everything that the human body interacts with causes damage
Using this approach can change the language that we use with clients and patients - in a good way. It's no longer about us versus a chemical or us versus a food, but more so about what our bodies do in response to said chemical or food.
We can use this concept of the body expressing itself to then suggest healthier alternatives and new routines, while discussing ways to minimize exposure to harmful toxicants, certain environments and even lifestyle choices.
This can be an empowering concept when clients learn about what in their environment may be affecting their case, as they can relate it back to what their body is trying to tell them about their current situation. We can then use this to show them how it’s possible to change the way that their body interacts with the environment, through lifestyle choices, diet modifications and other things that affect biology.
#3 - With deeper understanding of the exposome, protocol creation evolves
As a practitioner using this model, one can create better, more tailored protocols by asking targeted questions, which in turn, allows us to find the low hanging fruit that will make big shifts for our clients.
This process can be a private one, with you as the practitioner picking up on what your clients and patients are saying, or, this can be a team effort - with you as practitioner, educator and guide - helping your clients and patients understand how they are affected by their environment and in turn, allowing them to pinpoint areas where they make change.
No matter what kind of holistic practitioner you are, using the concept of the exposome will allow you to go deeper with your clients and patients, while expanding your ability to make radical changes.
What do you think about the exposome? Share your thoughts in the comments section below.
Author : Sidney Shindle, Co-Founder, Fiore Health
Rappaport SM, Smith MT, Epidemiology. environment and disease risks. Science 330, 460–461 (2010).
Vermeulen R, Schymanski EL, Barabási AL, Miller GW. The exposome and health: Where chemistry meets biology. Science. 367(6476):392-396 (2020)